Uterine Prolapse

Overview, Causes, & Risk Factors

Uterine prolapse is the "dropping" of the uterus from its normal position at the top of the vagina. It drops to a lower part of the vagina and may even drop outside the vagina. This is caused by a relaxation of the ligaments that support the uterus within the abdominal walls.

What is going on in the body?

Uterine prolapse occurs more commonly in white women, and in women who:

have given birth vaginally to many children

have given birth to large babies

have had forceps deliveries

These things may have caused injury to the pelvic ligaments and muscles. Symptoms may not occur until many years after women have given birth. This suggests that aging and shrinkage of these muscles also adds to the problem.
Uterine prolapse sometimes occurs in women who have never given birth. In these cases, the condition is due to a family tendency to have weak muscles that hold the uterus in place.
Some women have what is known as a "tipped uterus." This type of uterus is especially at risk to prolapse. This is due to its alignment along the same line as the vagina. It may be subject to a "piston-like effect." This happens when a woman uses her abdominal muscles, which push the uterus down into the vagina.
There are many different degrees of prolapse. Incomplete prolapse occurs when the uterus drops only partway into the vagina. Complete prolapse occurs when the uterus and cervix protrude out of the vagina and the vagina becomes inverted. Along with uterine prolapse there may be relaxation of the front and back portions of the vagina. This can cause a part of the bladder or rectum to protrude into the vagina.

What are the causes and risks of the condition?

The risk factors for developing uterine prolapse include:

multiple vaginal births

giving birth to large babies (more than 9 pounds)

difficult instrumented deliveries (forceps, vacuum)

presence of a pelvic tumor

diabetes

obesity

asthma

chronic bronchitis

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Symptoms & Signs

What are the signs and symptoms of the condition?

Mild prolapse may not cause any symptoms. With more severe prolapse, a woman may have:

a falling out sensation

a feeling like she's sitting on a ball

sensation of pelvic heaviness

low backache

lower abdominal discomfort

increased vaginal discharge

increased urinary tract infections

increased desire to urinate or more frequent urination

stress incontinence, or leakage of urine that is worsened by coughing, sneezing, or lifting objects

a feeling of not having completely emptied the bladder

constipation

painful bowel movements

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Diagnosis & Tests

How is the condition diagnosed?

A healthcare provider can tell during a pelvic exam if the cervix is in a lowered position in the vagina. The pelvic exam may also show a part of the bladder or rectum protruding into the vagina.

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Prevention & Expectations

What can be done to prevent the condition?

While uterine prolapse is not always avoidable, some cases can be avoided by:

doing Kegel exercises during pregnancy and after giving birth to strengthen pelvic muscles

an episiotomy, or cut made in the perineum and vaginal wall during labor

taking hormone replacement therapy for a long time during and after menopause to maintain the tone of the pelvic muscles

What are the long-term effects of the condition?

The long-term effects of uterine prolapse depend on how severe it is and how long a woman has had the condition. Some long-term effects include:

abnormal uterine bleeding

increased vaginal discharge

chronic vaginal infections

chronic bladder infections, known as recurrent cystitis

partial urethral obstruction

hemorrhoids

small bowel obstruction

incarceration of the uterus within the pelvis. This occurs with rapid growth of a pregnant uterus that becomes trapped in the pelvis, cutting off its blood supply.

What are the risks to others?

Uterine prolapse is not contagious, and poses no risk to others.

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Treatment & Monitoring

What are the treatments for the condition?

Treatment for uterine prolapse depends on many things, including:

the severity of the prolapse

the severity of the symptoms

the presence of other signs and symptoms

a woman's wishes to preserve her fertility

the woman's age

Treatment options include:

pessary, a plastic doughnut-shaped device placed into the vagina to push up the uterus

round ligament suspension procedure, an operation to provide muscle support to the uterus

estrogen therapy given directly into the vagina with creams

hysterectomy, or surgery to remove the uterus

What are the side effects of the treatments?

The side effects depend on the treatment. The use of hormone replacement therapy may cause nausea, weight gain, abdominal bloating, increased vaginal discharge, and breast tenderness. After a hysterectomy a woman will need 6 to 8 weeks to recuperate. There are possible side effects with any surgery. These include bleeding, infection, and allergic reactions to anesthesia.

What happens after treatment for the condition?

After surgical treatment of a prolapsed uterus, a woman should:

avoid lifting heavy objects

prevent constipation by drinking plenty of fluids, using stool softeners for a short time, and increasing her fiber intake

perform Kegel exercises daily

avoid smoking

lose weight through diet and exercise, if she is overweight

continue with hormone replacement therapy, if she was using it before surgery

avoid wearing tight girdles or other garments that put pressure on the abdomen

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

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Attribution

Author:Eva Martin, MD
Date Written:
Editor:Smith, Mary Ellen, BS
Edit Date:07/19/00
Reviewer:Gail Hendrickson, RN, BS
Date Reviewed:04/09/01

Sources

The Merck Manual of Medical Information, Home edition, 1997
Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998
Tierney, Lawrence, editor, "Current Medical Diagnosis and Treatment, 39th edition", 2000

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